This article is part of a series from San Diego Foundation that provides voters with an independent and objective explanation of the issues Measure B focuses on and how it could affect San Diego County communities.

In Brief

• Healthcare access in San Diego County is under growing strain as federal Medicaid funding reductions and new state budget constraints threaten health coverage and put additional pressure on local providers.
• More than 1 in 4 San Diego County residents—more than 850,000 people—are enrolled in Medi-Cal, California's Medicaid program, according to County of San Diego Health and Human Services Agency data.
• More than 300,000 San Diego County residents could lose access to healthcare or food assistance because of federal policy changes, according to the County of San Diego.
• Limited healthcare access can force families to delay care, rely on emergency rooms and choose between paying for healthcare and other basic needs, such as housing, food and childcare.
• San Diego County voters will decide in November 2026 whether to approve Measure B, the San Diego County Health & Safety Act, a countywide sales tax measure that would direct a majority of its revenue toward healthcare, including care for children and uninsured or underinsured residents.

What Is Healthcare Access?

Healthcare access means being able to get needed medical care reliably, affordably and in a timely way.

Medi-Cal, California's Medicaid program, functions as San Diego County's largest safety net for healthcare coverage, providing free or low-cost care to residents who qualify. The program covers doctor visits, prescription medications, emergency care, mental health support, pregnancy care and many other services, making it a vital resource for both public health and economic stability.

More than 1 in 4 San Diego County residents rely on Medi-Cal for coverage, according to the County of San Diego Health and Human Services Agency. That reliance is especially significant in a region where high housing costs and the rising cost of living already strain household budgets, according to the San Diego Economic Equity Report commissioned by San Diego Foundation. Without reliable healthcare access, residents may delay care or wait until symptoms become severe before seeking treatment, potentially increasing reliance on hospital emergency rooms.

Why Is Healthcare Access Under Pressure in San Diego County?

Healthcare access in San Diego County is under pressure primarily because of a historic reduction in federal Medicaid funding, compounded by new state budget constraints and long-standing workforce shortages at local healthcare providers.

It is estimated that the federal budget reconciliation law known as H.R. 1 will cut nearly $1 trillion from Medicaid nationally—the largest funding reduction in the program's 60-year history—and the nonpartisan Congressional Budget Office estimates that as many as 10 million people nationwide could become uninsured by 2034 as a result, according to the California Healthcare Foundation.

Medi-Cal could lose more than $30 billion in federal funding annually once the changes are fully in effect, according to CalMatters. Estimates of how many Californians could lose coverage vary depending on methodology and which policy changes are counted: the nonpartisan Legislative Analyst's Office projects roughly 1.2 million disenrollments from federal H.R. 1 changes alone; the California Budget & Policy Center puts the figure at up to 2 million; and an CA State Assembly Health Committee analysis that combines H.R. 1 with additional state budget changes puts the upper bound at 3.4 million disenrollments.

New work-and-reporting requirements and more frequent, six-month eligibility renewals are now law. What remains uncertain is exactly how many San Diego County residents will ultimately lose coverage. According to San Diego County, H.R. 1 is putting more than 300,000 residents at risk of losing healthcare coverage. It’s unclear how that loss will affect people's health and finances over time.

California is also restructuring how it funds behavioral healthcare, moving from the Mental Health Services Act to a new Behavioral Health Services Act. That transition could affect early childhood mental health programs, including First 5 San Diego's Healthy Development Services, according to First 5 Association of California. Reduced funding for prevention and early intervention could make it harder for young children to receive support during a critical period for healthy brain, social and emotional development.

For patients, the consequences of these changes could mean losing access to routine doctor visits, medications, emergency care, mental health support, pregnancy care and other services. For providers, the pressure runs in the opposite direction: federally qualified health centers—the safety net clinics that by law cannot turn away patients regardless of ability to pay—could be required to absorb a growing share of uncompensated care, a burden many cannot sustain indefinitely without risking closure.

Local health systems are also facing financial and workforce pressures. Sharp HealthCare, one of San Diego County's largest nonprofit health systems, announced workforce reductions affecting 260 employees in August 2026—on top of 315 positions eliminated in 2025—citing rising costs alongside federal policy changes tied to H.R. 1, according to a news story by the San Diego Union-Tribune.

Related administrative changes are also straining San Diego County's food-assistance program, CalFresh, which is closely tied to family health and stability. The county estimates it could need roughly $30 million a year in additional staffing to handle new federal paperwork requirements. Nationally, SNAP/CalFresh participation fell 11% between July 2025 and April 2026, with more than 4 million people losing food assistance so far—many of them children—according to NPR.

How Does Healthcare Access Affect Individuals and Communities?

When healthcare access shrinks, the effects extend well beyond the doctor's office and into family budgets, workplaces and the broader safety net.

Losing coverage or facing steep healthcare costs can force families to choose between paying for housing, food, childcare or healthcare—trade-offs that ripple into people's ability to work and contribute to the local economy. At the same time, healthcare facilities forced to absorb rising uncompensated care costs face their own risk of scaling back services or closing, which can reduce access even for patients who remain insured, since fewer providers are left to serve the same community.

For residents who lose Medi-Cal coverage, local safety-net programs may become increasingly important. In March 2026, the San Diego County Board of Supervisors voted to overhaul County Medical Services (CMS), the county’s safety-net program for uninsured adults who don’t qualify for Medi-Cal. County staff described CMS as the most restrictive program of its kind among large California counties.

Why Is Healthcare Access Especially Challenging in San Diego County?

San Diego County's high cost of living, large population of residents who rely on Medi-Cal and ongoing healthcare workforce pressures can make it especially difficult for residents to get affordable, timely care.

More than 1 in 4 San Diego County residents rely on Medi-Cal for health coverage.

These pressures, combined with cross-border public health dynamics unique to a diverse, binational region, create distinct challenges for San Diego County’s healthcare system.

Recent and upcoming changes in healthcare policies may also disproportionately affect certain populations including immigrants, refugees, adults without children, senior citizens and people with disabilities.

These and other factors help explain why Medi-Cal enrollment declined by approximately 5%, or 730,000 people, between June 2025 and March 2026, according to recent data from the California Department of Healthcare Services and published in the California Health Care Foundation’s tracking tool.

What Solutions Are Experts Exploring?

There is no single solution that can replace billions of dollars in public healthcare funding. Federal and state changes are expected to put significant pressure on coverage and providers, while the resources available through philanthropy, nonprofits and other sectors are not large enough to make up the difference.

In the near term, much of the focus is on protecting the coverage that remains. Advocacy and community organizations are working to help eligible residents understand changing requirements, complete necessary paperwork and avoid losing coverage because of administrative barriers. At the same time, healthcare providers are preparing to serve patients who may become uninsured or experience gaps in coverage—a need that could require far more funding than philanthropy or other community resources can provide.

Regional advocacy and provider organizations, including the Health Care Association of San Diego and Imperial Counties and the California Pan-Ethnic Health Network, are also working to inform state and local policy responses. CPEHN, for example, has analyzed how proposed state budget changes could affect healthcare access and affordability.

Philanthropy can play a more targeted role by supporting organizations that help residents maintain access to care and by directing resources to specific community needs. The San Diego Unity Fund, for example, was created by San Diego Foundation in response to federal cuts affecting food, housing and health programs. A $100,000 Unity Fund grant to the UC San Diego Shiley EyeMobile for Children is projected to provide vision screenings, exams and glasses for more than 5,000 local students. Another approach is bringing public and philanthropic resources together. Through the Partnership to Protect San Diegans, San Diego Foundation and the County of San Diego are helping local nonprofits maintain essential services affected by federal funding changes. The partnership includes a Matching Stabilization Fund designed to help preserve County-contracted nonprofit services during periods of funding uncertainty.

These efforts cannot replace public healthcare funding at scale, but they can help preserve access to essential services, support providers and help eligible San Diegans navigate a changing healthcare system.

Other potential responses are being explored through public policy, including Measure B, the San Diego Health & Safety Act, a local proposal that could affect healthcare funding in San Diego County.

What Is Measure B and How Could It Affect Healthcare in San Diego?

If approved by voters in November 2026, Measure B—also known as the San Diego Health & Safety Act—would raise San Diego County's sales tax by half a cent and direct a majority of the new revenue toward healthcare, including care for children and uninsured or underinsured residents.

Measure B is a countywide citizens' initiative, not a measure placed on the ballot by county government; its proponents qualified it for the November 2026 ballot by submitting more than 150,000 signatures to the county Registrar of Voters, according to KPBS. If approved, it would raise the county's sales tax rate from 7.75% to 8.25%, generating an estimated $400 million to $450 million annually.

According to the citizens’ initiative, up to 60% of new revenue would go toward childcare and health services for children, healthcare for uninsured or underinsured residents, food aid and other health-related causes; roughly 22.5% would go toward Tijuana River sewage crisis remediation; and roughly 16% would go toward public safety services, including wildfire prevention and emergency response.

Within the healthcare and childcare allocation, the measure specifically earmarks 6% of total revenue for early childhood mental and behavioral health services, including but not limited to the First 5 San Diegos Healthy Development Services program—a provision that connects directly to the state's broader shift from the Mental Health Services Act to the new Behavioral Health Services Act, according to First 5 Association of California.

Readers who want to review the measure's full legal text, including specific provisions on healthcare funding, oversight and accountability, can see the Registrar of Voters’ official summary at sdvote.com.

Like any ballot measure, Measure B raises broader policy questions, including whether a permanent local sales tax is the appropriate way to fund these investments amid a high cost of living and how responsibility for healthcare funding should be shared among federal, state and local governments. Additional nonpartisan information is available at SDFoundation.org/MeasureB.

Looking Ahead

Healthcare access in San Diego County is likely to remain under strain for years, regardless of how any single funding decision unfolds.

Because H.R. 1 represents the largest reduction in Medicaid funding in the program's 60-year history, according to the California Health Care Foundation, its effects will phase in gradually over the next several years rather than arrive all at once—with new eligibility redeterminations beginning in 2027 and new cost-sharing requirements following in 2028. Nonprofits, healthcare providers and community-based organizations across San Diego County are working to keep as many residents covered as possible throughout that transition, and community-based organizations outside the clinical system are expected to play a growing role helping residents navigate eligibility and enrollment.

Improving healthcare access in the years ahead could require additional local, state or federal funding, simplified eligibility requirements and continued support from healthcare providers and community organizations. Given the scale of the changes, maintaining access will likely require coordinated action across government, healthcare providers and philanthropy rather than any single funding source.

Frequently Asked Questions

What is healthcare access?

Healthcare access means being able to get needed medical care reliably, affordably and in a timely way. Having insurance is part of healthcare access, but it does not guarantee it—cost, provider availability and paperwork requirements can all impact timely care.

Why is healthcare access getting harder in San Diego County?

A historic reduction in federal Medicaid funding under H.R. 1, combined with new state budget constraints and existing healthcare workforce shortages, is straining coverage and provider capacity across San Diego County.

Why are there healthcare worker shortages?

Rising labor and supply costs, combined with stagnant government reimbursement rates, have pushed some San Diego health systems to reduce staff even as demand for care continues to grow. Sharp HealthCare's 2026 workforce reductions are one recent local example.

Why do doctor appointments take so long?

Healthcare workforce shortages and growing demand on safety-net providers can make it harder to get timely appointments. When fewer providers are available to serve the same or a growing number of patients, wait times can increase.

What is Medi-Cal?

Medi-Cal is California's Medicaid program. It provides free or low-cost healthcare coverage to eligible low-income residents, covering services such as doctor visits, medications, emergency care, mental health support and pregnancy care.

What is the difference between Medicaid and Medi-Cal?

Medicaid is the federal health coverage program for low-income Americans, jointly funded by the federal government and the states. Medi-Cal is simply California's name for its state Medicaid program.

How many San Diego County residents rely on Medi-Cal?

More than 850,000 San Diego County residents, or more than 1 in 4 residents, are enrolled in Medi-Cal, according to the County of San Diego Health and Human Services Agency.

What would Measure B, the San Diego Health & Safety Act, do if approved?

If approved by voters in November 2026, Measure B would raise San Diego County's sales tax from 7.75% to 8.25%, generating an estimated $400 million to $450 million annually. Up to 60% of that revenue would go toward childcare and health services for children, healthcare for uninsured or underinsured residents, and food aid, with the remainder split between Tijuana River sewage remediation and public safety. More information at SDFoundation.org/MeasureB.